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2009-376 �- TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761.8256 "r C ATE "N" COMPLIANT" k-jr1XI 1FR.01-vi. %..,Iu - - - k-M Permit Number: P20090376 Date Issued: Monday, August 24, 2009 This is to certify that work requested to be done as shown by Permit Number P20090376 has been completed. Tax Map Number: 523400-301-017-0001-047-000-0000 Location. 31 JOHN St Owner.. BARBARA CHERRY Applicant: BARBARA CHERRY This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the r property owner of the responsibility for compliance with Site Plan, Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090376 Application Number. A20090376 Tax Map No: 523400-301-017-0001-047-000-0000 Permission is hereby granted to: BARBARA CHERRY For property located at: 31 JOHN St in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: BARBARA CHERRY Septic Alteration Residential 38 JOHN St QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans &Specifications 2009-3 76 septic alteration residential $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 18,2010 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Tga�arrt�,Quee u da August 18,2009 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement VIP— ___.______.____ ____ . _ ..................IFFICE USE ONLY _ ZTAX MAP NO. PERMIT NO. ERMIT FEE 1; -� Q i; €� i� o APPROVALS: ZONING TOWN CLERK I� -- - -- -----------______________---------_______........ ______ APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEVaO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: ( �� a INSTALLE j % 9�-L a x : ADDRESS: U J '� `G ADDRESS: - PHONE NOS. ! J Y(J S'9 PHONE NO 7 9 (a y LOCATION OF INSTALLATION:3l / y / RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= TOTAL DAILY FLOW BEDROOMS GARBAGE GRINpE 1980 or older X 150 gallon per bedroom = ��� INSTALLED? 1981 -1991 X 130 gallon per bedroom - SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED?_ PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat roiling_ Steep slope %Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At wha epth? ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is per minute per inch. (Test to be completed by a licensed professional engineer or architect.) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). TANK SIZE: J �GALLON (MI . SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: X ABSORPTION FIELD (WITH NO. 2 STONE) Total length .-20J ft. Each trench ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? ::.:::........:....:........:.:.:..:.......:::::::..::::.......:........................::....:::..::...::....:.:......::...::....:.:.:....:.:...................:.. ::..::......................... . . NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or \ v ' Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: t7 U� Queensbury Building &Code Enforcement Arrive: amJ m Depart: ��%am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: tt ll''--'' A NAME: S ' PERMIT'NO . `f 7 LOCATION: INSPECT ON: .. ?-/-_ j RECHECK: / Comments and/or diagram Soil Ty am/ Clay Type of Water: u / Well Water Waterlin ration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + - Y N N/A Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit '` Opening Sealed: N End CapN Inlet/Outlet Pipes&Baffles Y N 24� Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. T Co orms as per Plot Plan N E and As-Built Y -- N Location of System Property: Front ar Left Side Right Side Middle Front Middle Rear System Use s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc